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Non-ketotic hemichorea-hemiballismus presenting as generalised tonic-clonic convulsive state in uncontrolled diabetes
  1. João Enes Silva1,
  2. Joana Margarida Moreira Esteves2,
  3. Ana Isabel Ferreira1 and
  4. Celeste Dias3,4
  1. 1Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
  2. 2Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
  3. 3Neurocritical Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
  4. 4Invited Professor, Faculty of Medicine, University of Porto, Porto, Portugal
  1. Correspondence to Dr João Enes Silva; joaosilva.fmup{at}


We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient’s history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.

  • epilepsy and seizures
  • diabetes
  • movement disorders (other than Parkinsons)
  • neuroendocrinology
  • neuroimaging

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  • Contributors All listed authors contributed directly both in some part of the patient in hospital care and in the manuscript draft and/or revision. JES and JMME first received the patient in the emergency room, suggested the diagnosis and allocated the patient to the intensive care unit, where the patient was received by CD. In the infirmary, the patient was under the care of AIF. The initial draft and bibliographical research for the manuscript was made by JES. JMME and AIF revised the initial draft and further contributed to the writing and bibliographical research of the clinical case. Final approval and revision of the submitted version was done by CD, given her expertise in the field of neurosciences and contact with the patient in the neurocritical care unit.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.